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Early and locally advanced breast cancer: diagnosis and treatment [CG80]

Measuring the use of this guidance

Recommendation: 1.1.2

Offer MRI of the breast to patients with invasive breast cancer: if there is discrepancy regarding the extent of disease from clinical examination, mammography and ultrasound assessment for planning treatment if breast density precludes accurate mammographic assessment to assess the tumour size if breast conserving surgery is being considered for invasive lobular cancer.

What was measured: Proportion of patients with invasive lobular carcinoma that had MRI preoperatively
Data collection end: December 2013
36.5%
Number that met the criteria: 46 / 126
Area covered: Local
Source: Derias M, Derias M, Subramanian A, et al. (2016) The Role of Magnetic Resonance Imaging in the Investigation and Management of Invasive Lobular Carcinoma-A 3-Year Retrospective Study in Two District General Hospitals Breast Journal 22 (4) : 384-389.


Recommendation: 1.4.3

Perform SLNB using the dual technique with isotope and blue dye.

What was measured: Proportion of units reporting the use of radioactive injection and dye to identify the sentinel node for sentinel lymph node biopsy.
Data collection end: March 2017
68%
Number that met the criteria: 86 / 127
Area covered: England and Wales
Source: Royal College of Surgeons. National Audit of Breast Cancer in Older Patients.

What was measured: Proportion of units reporting the use of radioactive injection and selective dye to identify the sentinel node for sentinel lymph node biopsy.
Data collection end: March 2017
24%
Number that met the criteria: 31 / 127
Area covered: England and Wales
Source: Royal College of Surgeons. National Audit of Breast Cancer in Older Patients.


Recommendation: 1.5.1

Discuss immediate breast reconstruction with all patients who are being advised to have a mastectomy, and offer it except where significant comorbidity or (the need for) adjuvant therapy may preclude this option. All appropriate breast reconstruction options should be offered and discussed with patients, irrespective of whether they are all available locally.

What was measured: Following establishment of oncoplastic multidisciplinary meetings in April 2015, the proportion of people who underwent breast reconstruction following a mastectomy.
Data collection end: March 2016
42%
Area covered: Local
Source: Breast cancer (Dove Medical Press) 2017 VOL 9 PP 293-296 Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting El Gammal , Mohsen M, Lim Maria, Uppal Rajan, and Sainsbury Richard


Recommendation: 1.10.1

Patients with early invasive breast cancer should have a baseline dual energy X-ray absorptiometry (DEXA) scan to assess bone mineral density if they: are starting adjuvant aromatase inhibitor treatment have treatment-induced menopause are starting ovarian ablation/suppression therapy.

What was measured: Proportion of patients with early invasive breast cancer that received a baseline dual energy X-ray absorptiometry (DEXA) scan to assess bone mineral density.
Data collection end: April 2013
38%
Number that met the criteria: 16 / 42
Data collection end: January 2014
90%
Number that met the criteria: 9 / 10
Data collection end: February 2014
92%
Number that met the criteria: 12 / 13
Data collection end: March 2014
100%
Number that met the criteria: 11 / 11
Area covered: Local
Source: Dong, H., Dayananda, P., Preece, S. & Carmichael, A. (2015) Are patients with newly diagnosed breast cancer getting appropriate DEXA scans? A District General Hospital experience, BMJ Quality Improvement Report, Vol 4, issue 1.


Recommendation: 1.14.1

Offer annual mammography to all patients with early breast cancer, including DCIS, until they enter the NHSBSP/BTWSP. Patients diagnosed with early breast cancer who are already eligible for screening should have annual mammography for 5 years.

What was measured: Proportion of NHS trusts in England that reported all early breast cancer patients having annual follow-up mammograms for 5 years.
Data collection end: March 2017
94%
Area covered: England and Wales
Source: Royal College of Surgeons. National Audit of Breast Cancer in Older Patients.



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